Robotic surgery and heart conditions

While robotic surgery for heart defects in children takes longer than conventional surgery, it cuts down on time in hospital. It also speeds up recovery, according to doctors at the University of Michigan Congenital Heart Center.

Robotic surgery involves the use of a surgeon-controlled, camera-guided robot system ond takes about 30 minutes longer than traditional surgery. It has shown promise in adult patients, including those with congenital heart conditions.

Doctors at the University of Michigan's C.S. Mott Children's Hospital started using the $1 million da Vinci robot system in November 2002. It is only used in a small number of heart-related procedures, though that number is expected to grow. This was the first study to compare robot-assisted surgery and traditional surgery.

Researchers found that the robotic surgery cut down on trauma and scarring. Because it is minimally invasive, the surgery has the same results as regular open chest surgery but with less impact on the body. The results of the study were presented recently at the annual meeting of the Society of Thoracic Surgeons.

The University of Michigan study looked at five patients with vascular ring and two with other heart defects who had robotic surgery. They were compared with 10 children who had open chest surgery for vascular ring. This is a rare defect in which blood vessels surround the esophagus and trachea, reducing a child's ability to breathe. The children who underwent robot-assisted surgery ranged in age from 1 to 10 years.

The seven children who underwent robot-assisted surgery were in the operating room for about 116 minutes and spent about two days in hospital. This compared to 83 minutes in the operating room and four days in hospital for children who had open chest surgery.

"We feel from our experience that it can be used on many paediatric patients weighing more than 10 kilograms, and can reduce hospital stays, operative trauma, cosmetic impact, and overall recovery time," stated University of Michigan surgeon Dr. Richard Ohye. "And we found it does so with an acceptable impact on a patient's time in the operating room."

He noted that the added cost of the technology is offset by reducing the time a child spends in the hospital after surgery, the complications faced during recovery, and parents' time away from work.

"Robotic surgery has the potential to be a significant advance in the field and has been adopted by some centres in North America as well as Europe. At present, the advantages are difficult to measure. Nevertheless, this technology reflects a trend towards less invasive surgical correction of congenital heart disease," said Dr. Chris Caldarone, a staff surgeon in the Department of Cardiovascular Surgery at The Hospital for Sick Children (Sick Kids) .

"At Sick Kids, we are making significant progress along these lines with our three-dimensional echocardiogram and magnetic resonance techniques, which will someday be the 'eyes' of the surgeon as we perform procedures inside the beating heart with the next generation of robotic technology."